One main area of expertise of our valve repair team is cardiac re-operations - performing repeat cardiac surgery on patients who have had previous heart surgery. These patients fall into three main groups.
- Patients who have had previous operations unrelated to the heart valves but now have a heart valve problem. A typical example would be a patient who has had coronary artery bypass surgery in the past and now has a leaking mitral valve.
- Patients who have had a previous mitral valve repair who subsequently developed a new leak through the valve, or where the surgeons had been unable to correct the leak at the first operation.
- Patients who have had previous valve replacements and now need another valve replacement because the previous valve is worn out, infected, not working properly or other reasons.
Re-operations pose a specific challenge at surgery because after the first operation the heart, and the body tissues around it, heal by scarring. Because all the tissues are stuck together, the risks of injury to the heart or blood vessels when getting into the chest is high. Additionally operating on valves for a second time can be technically challenging because of scarring around the valve, and old artificial material such as artificial valves, rings, sutures and pieces of fabric which were placed at previous operations.
Dr. Anyanwu has a special interest in cardiac re-operations and with our team has adopted and refined methods of re-entering the chest safely that are adaptable to almost all scenarios. Because Dr. Anyanwu runs our heart transplant and artificial heart program, he is accustomed to doing the most complicated of re-operations (as most patients having heart transplant have had one or more previous heart operations).
Many of the re-operations we do are complex re-operations. These are re-operations in particularly high risk patients (such as those who have poor heart function, elderly patients, patients with major medical illnesses), patients who have had more than one previous heart operation, patients who had a complicated course after their first operation, patients who need surgery on more than one heart valve, or need bypass grafts in addition to heart valve surgery. All complex re-operations are also managed by our high-risk cardiology team lead by Dr. Sean Pinney. This team will independently perform an assessment of these patients and reconfirm that surgery is the most appropriate treatment for the patient's heart problem. The high-risk team also gives advice on how we can optimize these patients (get them in the best shape for surgery, thereby reducing the risks of surgery) and will also participate in the care after surgery. For all complex re-operations we have the back-up of ventricular assist devices - which are heart pumps that can be placed to assist function of the heart if the heart becomes very weak after the operation.